Word: breast
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Tawnya Geisbush wakes up every day fighting two battles--one against breast cancer, the other against her insurance company. It's hard to say which is the more stubborn opponent...
Geisbush, 32, a veterinarian from Phoenix, Ariz., was recently found to be suffering from metastatic breast cancer, an especially aggressive malignancy that had already ranged well beyond the site of the original disease. Eventually she and her doctors agreed they should attack the advancing cancer with what many people believe is the most potent weapon available: high-dose chemotherapy accompanied by a transplant of stem cells, precursors of disease-fighting immune-system cells...
...reinfused into the body, in the hope that the immune system will rebound. Punishing as the therapy is, advocates say it can work, and patients are clamoring for it--but at no small price. In the U.S., well over half a billion dollars may have been spent on breast-cancer-related transplants in the past 10 years...
Some insurers, however, had long dug in their heels over transplant therapy, and last week's announcement may make them dig deeper still. The five new studies looked at two types of breast cancer: high-risk cases, in which the disease has spread to 10 or more lymph nodes; and metastatic cases, in which it's migrated even further. Of the three studies that focused on high-risk cases--surveying a total of 1,462 breast-cancer patients--only one found a statistically significant advantage for transplant therapy. The two studies that focused on metastatic disease showed no real advantage...
...insurers will react to all this is unclear. US Healthcare (now merged with Aetna) and some Blue Cross/Blue Shield plans helped bankroll three of the recent studies, an act of good corporate citizenship that seemed to signal a willingness to keep paying for transplant treatments in breast-cancer cases. A doctor working with Kaiser-Permanente, the nation's largest HMO, offers more direct reassurance. "It will be up to the doctor and the patient," predicts oncologist Louis Fehrenbacher...